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Hair transplantation with FUE method PDF Print E-mail

Hair Transplantation with FUE (Follicular Unit Extraction) method

What is Follicular Unit Extraction?

 Follicular Unit Extraction (FUE) is a method of obtaining donor hair for Follicular Unit Transplantation (FUT), where individual follicular units are harvested directly from the donor area, without the need for a linear incision. In this hair restoration procedure, a 1-mm punch is used to make a small circular incision in the skin around the upper part of the follicular unit, which is then extracted directly from the scalp.

 Using direct extraction to harvest follicular units was initially introduced by Dr. Woods in Australia as the "Wood's Technique," but he did not disclose the details of his technique. The procedure was first described in the medical literature by Rassman and Bernstein in their 2002 publication "Follicular Unit Extraction: Minimally Invasive Surgery for Hair Transplantation." This paper gave the procedure its current name and described the FOX test used to identify patient variability. The procedure was further refined by Dr. Jim Harris by adding an additional step of blunt dissection to the technique.

Because FUE does not leave a linear scar, it is used for patients who want to wear their hair very short. The procedure is also useful for those who have healed poorly from traditional strip harvesting or who have a very tight scalp. Possibly the most important application of this technique is to camouflage a widened linear donor scar from a prior hair transplant procedure

Patients differ significantly with respect to the ease in which the units can be removed from the scalp, with extraction in some patients producing unacceptable levels of transaction (damage due to cut hair follicles). All patients considering FUE should be tested for the ease of extraction (the FOX Test) so that those in whom extraction is difficult, or who show significant degrees of transaction, can be identified in advance.

Our method, Three-Step FUE

 A significant advance in Follicular Unit Extraction has been the addition of "blunt" dissection to the original technique of "sharp" dissection followed by extraction. This was described by Dr. Harris at the ISHRS in 2004. In this three-step technique, a sharp punch is used to score the epidermis (cut just the upper part of the skin) and then a dull punch is used to bluntly dissect (separate) the follicular unit grafts from the surrounding deeper dermis. The third step is the same, namely removing the follicular graft from the scalp using fine forceps.

 The advantage of this hair transplant technique over the original two-step process is that using a dull punch minimizes follicle transection (damage). As the blunt-tipped punch is advanced into the dermis, the follicles, which naturally separate deeper in the skin, are "gathered together" within the opening of the instrument, rather than risk the lower portions of the follicles being cut off. Another significant advantage of the new technique is that it increases the number of patients who are FOX positive and thus who are able to benefit from FUE.

The Advantages and Disadvantages of Follicular Unit Extraction

FUE's main limitation, when compared to FUT, is that it is less efficient in harvesting hair from the mid-portion of the permanent zone. In FUT, the strip is taken from the optimal (central) part of the donor region so all the hair in this area can be removed and transplanted. After the strip is removed, the wound edges are sewn together.

  • No linear scar,Important for those who wear their hair short
  • Decreases healing time in the donor area
  • Useful for those with a greater risk of donor scarring (Asians)
  • Ideal for repairing donor scars that cannot be excised
  • No limitations on strenuous exercise after the procedure,Less post-op discomfort
  • Provides an alternative when the scalp is too tight for a strip excision


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